Organization
ADVANCED INTERNAL MEDICINE, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHAHRAM DANIEL SHAMEKH M.D. (PRESIDENT/CEO)
(516) 455-7017
Entity
Organization
Contact information
Practice address
935 NORTHERN BLVD STE 105, GREAT NECK, NY 11021-5309
(516) 487-0070
(516) 487-0072
Mailing address
130 GRISTMILL LN, GREAT NECK, NY 11023-1839
(516) 455-7017
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
236142
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02708294
—
NY
Enumeration date
08/08/2012
Last updated
11/28/2018
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